Aim:We compare the outcome of three different methods of graft extraction after a laparoscopic donor nephrectomy.Materials and Methods:After a conventional five port laparoscopic donor nephrectomy, specimen was extracted through one of three approaches: 1. Iliac fossa (IF) incision and hand extraction, 2. Midline (MD) periumbilical with a lower polar fat stitch incorporating gonadal vein for traction while retrieval, and 3. Pfannensteil (PF) with Gel port extraction. Estimated blood loss, operating time, warm ischemia time, incision length, pain score, analgesic consumption, hospital stay, wound complications, graft complications and recipient creatinine at 6 weeks were analyzed.Results:Warm ischemia time was significantly reduced in PF group when compared to other groups. Length of the incision was less in the MD group compared to other groups. Wound complications were significantly less in PF group when compared to other groups. Graft extraction complications were significantly high in MD group compared to other two groups.Conclusion:Based on the results obtained, our current method of preference is by Pfannensteil incision. A controlled extraction with the use of a hand assist device would be best for donor safety and to avoid graft related complications.
Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To present our long‐term experience comparing uretero‐intestinal anastomotic (UIA) stricture rates after radical cystectomy (RC) in patients with and without previous pelvic radiotherapy (pRT), as the risk of stricture is thought to be higher in patients undergoing RC and urinary diversion (UD) with a history of pRT. PATIENTS AND METHODS We retrospectively analysed patients who had RC and UD between 1992 and 2008 by one surgical team. Patients were divided into two groups, those with (group 1) and with no (group 2) previous pRT. Relevant clinical and pathological data were entered into a database. Patients who were symptomatic and required intervention for a UIA stricture were analysed; patients with malignant strictures were excluded. RESULTS In all, 526 patients had RC by one surgical team during the study period; 65 had pRT before RC, 37 for prostate cancer, 23 for bladder cancer and the rest for other pelvic malignancies. All the patients in group 1 had an ileal conduit (IC) diversion. There were 250 IC and 211 neobladder diversions in group 2. There were 130 (12%) UIAs in group 1, vs 922 (88%) in group 2. There was no statistically significant difference between the groups in demographic profile and follow‐up. The overall stricture rate for UIA was 1.3%; there were two (1.5%) UIA strictures in group 1 vs 12 (1.3%) in group 2. The mean (median, range) time to onset of the stricture was 10 (6, 2–39) months. There was no statistically significant difference in stricture rate between the groups (P > 0.05). CONCLUSIONS In patients undergoing RC with UD there was no significant difference in UIA stricture rates between those with and without previous pRT.
Purpose: Many urologists recommend a six-week time interval between a prostate biopsy and a total prostatectomy (TP) to allow the biopsy induced inflammation to subside. Our aim was to assess whether the time interval between prostate biopsy and TP has an impact on the surgical outcome. Materials and Methods: A retrospective analysis was performed on data from patients who underwent a TP by a single surgeon from 1992 to 2008. The patients were divided into two groups according to the time interval between biopsy and TP, Group 1 ≤ 6 weeks and Group 2 > 6 weeks. Relevant perioperative variables and outcome were analyzed. Results: 923 patients were included. There was a significant difference between the two groups in the surgeons' ability to perform a bilateral nerve sparing procedure. Those who had a TP within six weeks of the biopsy were less likely to have a bilateral nerve sparing procedure. No significant difference was noted in the other variables, which included Gleason score, surgical margin status, estimated blood loss, post-operative infection, incontinence, erectile function, and biochemical recurrence. Conclusions: TP can be safely performed without any increase in complications within 6 weeks of a prostate biopsy. However, a TP within six weeks of a biopsy significantly reduced the surgeon's perception of whether a bilateral nerve sparing procedure was performed.
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